Atrial septal interventions in patients with hypoplastic left heart syndrome.
OBJECTIVE
To report an institutional experience performing percutaneous atrial septal interventions in patients with hypoplastic left heart syndrome (HLHS).


BACKGROUND
The success of the Hybrid approach in palliating patients with HLHS is crucially dependant on relieving any significant interatrial restriction. Data on transcatheter interventions to relieve atrial septal restrictions in patients with HLHS are limited.


METHODS
We retrospectively reviewed 67 transcatheter atrial septal interventions that were performed between July 2002 and September 2007 in 56 patients with HLHS. The median weight was 3.35 kg. About 10.7% of patients had an intact atrial septum. Balloon atrial septostomy (BAS) was used in 77.6% of procedures, additional techniques in 35.8% of procedures. Patients were divided into those with standard atrial septal anatomy (group A, n = 33) and those with complex atrial septal anatomy (group B, n = 23).


RESULTS
The mean trans-septal gradient was reduced significantly from 7 mm Hg to 1 mm Hg with the median time to discharge being 3.5 days. Major adverse events were seen in 8.9% of procedures, whereas minor adverse events occurred in 26.8% of procedures. Adverse events were significantly less common in patients with standard atrial septal anatomy, compared to those with complex atrial septal anatomy (25.6% versus 50.0%). About 19.6% patients required repeated atrial septal interventions. Survival up to and including Comprehensive stage II palliation was 73% group A, and 57% in group B.


CONCLUSIONS
With utilization of appropriate techniques and equipment, atrial septal interventions in HLHS can be performed successfully in virtually all patients. Complex atrial septal anatomy is technically challenging and has a higher incidence of procedural adverse events. In the majority of patients, standard BAS can be performed safely, and is usually the only intervention required to achieve adequate relief of atrial septal restriction until Comprehensive stage II palliation.
Holzer
Ralf J
RJ
Cardiology Division, The Ohio State University, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio 43205, USA. RHolzer@chi.osu.edu
Wood
Amy
A
Chisolm
Joanne L
JL
Hill
Sharon L
SL
Phillips
Alistair
A
Galantowicz
Mark
M
Cheatham
John P
JP
D000800:Angioplasty, Balloon; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017023:Coronary Angiography; D003664:Decompression; D017548:Echocardiography, Transesophageal; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome